Prior to and during colorectal surgery it is frequently necessary to lavage the rectum and distal colon either with an irrigation solution, a topical preparation, or both. It is however difficult to efficiently lavage the entire area, particularly when it is necessary to lavage the distal colon, and it is also difficult to contain and hygienically drain the waste fluid.
The most common known method uses a proctoscope inserted into the anal canal of the patient, through which lavage solution is injected into the rectum using a syringe. However, the proctoscope requires the use of an obturator for insertion which is then removed, leaving an unsealed opening and no means of containing the outflow of lavage fluid. It is thus difficult to contain fluid inside the patient for an adequate lavage, and there is no sealed or closed means of collecting draining fluid. Furthermore, use of a syringe limits the capacity to direct lavage fluid inside the patient.
The limitations of using a syringe can be overcome by using another known method, that of inserting a catheter or similar through the proctoscope and advancing it through the rectum and along the distal colon. This provides the capacity to direct lavage fluid, but not contain or drain it.
Another known method uses the A4050 “Colo-shower” available from SAPIMED SpA, Alessandria, Italy. The proctoscope is inserted using an obturator, the obturator is withdrawn and a plug with a sealing means inserted in the distal end of the proctoscope. A catheter is fed through the sealing means and into the patient as described above. Fluid drains through an outlet port into a receptacle provided by the user. Although the fluid outflow is restricted, it is not possible to completely contain the fluid in the patient, and the diameter of the outlet port is very narrow and may easily block.
We are aware that U.S. Pat. No. 5,443,445 (Peters et al./Clinical Product Development Limited) describes an intra-operative colon irrigation system which includes a device having a tubular body with a forward end formed by a dome-shaped nozzle to prevent intussusception of the bowel, and a side tube including an outlet for the discharge of fecal matter from the device. A port is located at the other end of the tubular body, for the insertion of an ultrasonic device or for the injection of water or air under pressure.